前降支弥漫性病变冠心病的外科治疗

Surgical treatment of coronary artery reconstruction for diffuse and extensive lesions of the left anterior descending artery

目的 :总结应用乳内动脉部分重建前降支治疗前降支弥漫性病变的冠心病的方法 ,以探讨该术式的治疗价值。方法 :2 6例病人中男 17例 ,女 19例 ;年龄 5 8～ 75岁 ,平均 6 3 2岁。有陈旧性心肌梗死史者 8例 ,3例有近期心肌梗死史 ,9例有不稳定心绞痛 ,均为三支血管病变 ,其中前降支为弥漫性病变。手术均在全身浅中度低温 ,中度血液稀释体外循环下施行。冷血心脏停跳液顺灌诱导、间断逆灌及终末温血灌注。前降支以左乳内动脉重建。前降支占重建后血管的 2 5 % ,而左乳内动脉占 75 %。结果 :无手术死亡。围术期心肌梗死 1例 ,占 1 2 6 (3 8% )。随访 1～ 6个月 ,1例术后心绞痛 ,再次造影示手术后降支吻合口血栓 ,其余病人无心脏事件发生。结论

Objective:To evaluate the surgical technique of coronary artery reconstruction for diffuse and extensive lesions of the left anterior descending artery.Method:Twenty\|six coronary artery reconstruction(CAR) using left internal mammary artery(LIMA)for diffuse and extensive lesions of the left anterior descending artery were performed,aged from 58～75 years old,mean 63.2 years old.Eight cases have the history of myocardial infarction(MI)and three recent MI.Nine cases have unstable angina and all have triple vessel disease.All cases were performed under cardiopulmonary bypass.Diseased LAD is bypassed with LIMA and the anastomosis is made from proximal lesion of LAD.The wall of the new reconstructed LAD consisted of 75% of LIMA and 25% LAD.Result:No perioperative death and one have the post\|MI and one post\|angina.The follow\|up was 1～6 months,no cardiac events occurred.Conclusion:CAR is an acceptable operative treatment for diffuse and extensive lesions of the left anterior descending artery and received good early results.